 |
|
|
 |
 |
 |
|
Susceptibility To Cavities |
|
 |
|
 |
|
|
|
 |
|
|
|
|
|
Holes in teeth are the result of our modern diet, particularly sugars and carbohydrates. A certain type of microbe feeds upon sugars, excreting acids that bore into enamel. After a hole is formed in a tooth, the acid-generating bacteria live in it and continue their dirty work: they form their own ecological niche, and eventually they make the cavity worse.
Dental caries (decay) is one of the most prevalent infectious diseases of man. It is a localized, progressive demineralization of the hard tissues of the crown (coronal enamel, dentine) and root (cementum, dentine) surfaces of teeth.
The pit-and-fissure surfaces of teeth are more susceptible to decay than are the smooth surfaces. It it is no surprise to find that the rear molar and premolar teeth that have pit-and-fissure surfaces are more susceptible than the front teeth. Based on epidemiologic studies, the pit-and-fissure biting surfaces of molar teeth usually decay within three years of eruption or not at all.
Incidence; Causes & Development; Risk Factors
Although great international and regional differences exist, the incidence and prevalence of coronal dental caries have declined in industrialized countries over the past 20 years. This change has been well documented for children and adolescents, and many children now have experienced no decay or fillings at all. In the U.S. in 1986-87, 50% of 5-17 year old children were completely free of decay and of restorations in their permanent teeth.
In adults, there have been small reductions in the number of decayed, missing and filled teeth and in the rate of total tooth loss. Amongst adults who have teeth, the decline in missing teeth has been more substantial. While it is believed that the marked improvement in dental caries status and greater tooth retention experienced by children will eventually be evident in adults, a long transition period of about 40 years will be required before improvement is evident in all adult age groups.
The extensive decline in dental caries has not benefited all children equally. U.S. data reveal that 20-25% of children still have high decay levels - the so-called high-risk children. Adults not yet benefiting from this decline still have decay and fillings characteristic of a previous era. Secondary decay around old fillings, replacement fillings and breakage of tooth cusps due to extensive fillings are commonplace in this age group and represent a large treatment backlog.
The demineralization is caused by acids produced by bacteria, particularly mutans Streptococci and possibly lactobacilli, that ferment dietary carbohydrates.
This process occurs within a bacteria-laden gelatinous material called dental plaque that adheres to tooth surfaces and becomes colonized by bacteria. Thus, caries results from the interplay of three main factors over time: dietary carbohydrates, cariogenic bacteria within dental plaque, and susceptible hard tooth surfaces. Dental caries is a dynamic process since periods of demineralization alternate with periods of remineralization through the action of fluoride, calcium and phosphorous contained in oral fluids.
Dental caries is age-related. Prevalence begins soon after tooth eruption in susceptible children and increases with age. Data from older Canadian studies, when dental caries were more prevalent, suggest that caries incidence had three peaks: at about age 7 years for coronal decay of the primary dentition; at about age 14 years for coronal decay of the permanent dentition; and, for root surface decay, incidence began at about age 30-40 years with steady increases thereafter.
Children and adults with special medical problems are at higher risk for dental caries. These include bulimics, those with Sjogren's syndrome, and those receiving therapeutic head and neck radiation, chemotherapy, or prolonged treatment with drugs that reduce salivary flow. Institutionalized and physically and mentally disabled persons are also at higher risk for dental caries.
Detailed reviews of the many risk factors and risk indicators for dental caries have been reported elsewhere. Age, socioeconomic status and past dental caries are strongly linked with dental caries incidence; oral hygiene as practised by most people is not strongly related to dental caries occurrence. Although past research indicated that sugar was a definite risk factor, more recent research findings about the effect of contemporary dietary practices on dental caries have given differing results except possibly for those at high risk because of high sugar intake and poor oral hygiene.
Diagnosis & Tests
Traditionally, the clinical detection of carious lesions on tooth crowns has involved the use of a sharp explorer, a viewing mirror, an artificial light source and air-drying of tooth surfaces to improve visibility. This visual and tactile approach is often supplemented by the use of selected radiographs to help in the diagnosis of small (incipient) lesions on the hidden surfaces between adjacent teeth. The early clinical detection of incipient carious lesions has attracted increased interest recently because of the possibility that primary preventive procedures used by patients or by dental personnel may enhance remineralization and even arrest dental decay.
Diagnosis of dental caries and treatment planning in clinical practice is idiosyncratic and plagued with considerable variation among dentists. This has been demonstrated when the same group of patients and the same set of radiographs were examined.
Treatment & Prevention
There are four types of primary prevention: fluorides; fissure sealants; dietary counselling; and oral hygiene.
Systemic Fluorides
This topic is covered here despite the belief by many that fluoride is not only ineffective but in fact harmful.
Despite the apparent reduction in effectiveness of water fluoridation due to declining caries levels (from about 50% reduction in decay to 20-40%), fluoridation of the water supply remains, according to many dentists, the single most effective, equitable and efficient means of preventing coronal and root dental caries. The impact of water fluoridation on coronal decay in children, adolescents and adults has been studied in numerous community trials and economic evaluations and the impact on root caries has been evaluated in case-control studies. Because of the widespread availability of fluorides (in dentifrices, water, vitamin supplements, manufactured beverages and food), there is now concern about increases in the prevalence of (usually) very mild fluorosis in children's teeth. Although mild fluorosis is usually neither unsightly nor easily visible, it is, nevertheless, evidence of excess fluoride intake.
A principal reason for the observed increase in fluorosis appears to be inappropriate prescribing of systemic fluoride supplements by dentists and physicians and/or overzealous use of these supplements by parents for their children. More recent modifications to the supplemental dose schedule to avoid fluorosis suggest lower intakes of fluoride supplements because of increased use of fluoride toothpastes and ingestion of other food and beverage sources of systemic (and topical) fluoride that were not widely available when previous guidelines were formulated.
Professionally-applied topical fluorides, e.g. acidulated phosphate F gel in trays, have been proven efficacious in randomized clinical trials in children, though there have been few trials since 1980, the era of decline in caries incidence. It has now been established that there is no need for a cleaning of the teeth prior to the application of a topical fluoride but similar evidence for biannual rather than annual applications is lacking.
Today, costly professionally-applied topical fluoride cannot be recommended for use with most children in communities with water fluoridation or, indeed, for most children generally because of the dental caries decline. However, this form of fluoride therapy is recommended for persons with active decay and those at high risk, for those undergoing head and neck radiation therapy and for older adults experiencing root caries.
Self-applied fluorides include the widely-used fluoride dentifrices that are strongly recommended because of their ease of use, low cost and effectiveness on coronal and root caries prevention based on randomized clinical trials. The primary reason for the caries decline in developed countries is invariably ascribed to fluoride dentifrices. However, concerns about a possible increase in mild tooth fluorosis have prompted recommendations to use less dentifrice and supervise the toothbrushing of young children.
Fluoride mouth rinses were recommended a few years ago for general use. However, because of the decline in caries and concerns about excess fluoride ingestion, they are now recommended only for those at high risk to dental caries and for those not regularly using a fluoride dentifrice. None of these rinses are intended for use in children under age 5.
Fissure Sealants
These are resins applied by dental personnel to the pit-and-fissure surfaces of posterior teeth. They have been extensively tested since 1979 in randomized clinical trials and have proven to be effective in reducing this most common form of surface decay. Because of their high cost, the general decline in decay and differential tendencies for certain fissures to decay, sealants should be applied selectively to high risk patients and to permanent molars only, within 2-3 years after tooth eruption.
Dietary Counselling
Encouragement to reduce sucrose intake and use dentally 'safe' substitutes may be less important now for the majority of persons. Two cohort dietary studies revealed that dental caries incidence was low among study children despite their high sugar consumption. In one study, the only apparent causative role of sugar was related to decay of smooth surfaces between the teeth; however, this type of surface decay has rapidly declined in children recently. The effectiveness of dental counselling in inducing behaviour change is suspect. Since sugars are one of the etiologic factors in the caries process, selective counselling limited to high-risk children may still be indicated. Similarly, because of the high risk of severe decay to infants' teeth due to this practice, the majority of studies do not advise the nocturnal or other prolonged use of baby bottles containing liquids other than water.
Oral Hygiene
Oral hygiene procedures consist of personal plaque removal by toothbrushing and/or flossing as well as the professional prophylaxis that often precedes a periodic dental examination. As ordinarily practised, in neither case is there evidence that these lead to caries reductions. Daily personal oral hygiene (toothbrushing and flossing) is recommended in the interest of good hygiene and for the control of gingival disease. Toothbrushing is also required for the self-application of fluoride dentifrice, a proven caries preventive.
|
|
|
|
|
Signs, symptoms & indicators of Susceptibility To Cavities:
Recommendations and treatments for Susceptibility To Cavities: | | | | | Dental |  Floss/Tongue Comb |
Diet |
Sugars Avoidance / Reduction |
Mineral |
 Magnesium | Magnesium is helpful in preventing some problems of the teeth, including cavities. For these purposes, a daily dose of 50mg of vitamin B6 and 200-300mg of magnesium is often given. |
|
Oxygen / Oxidative Therapies |
 Ozone / Oxidative Therapy| | (Reported in Time magazine, September 2002) Edward Lynch, of the Royal Victoria Hospital's School of Dentistry, has come up with a technique that allows saliva to help decayed teeth repair themselves naturally. The remedy that he discovered is ozone. The bad bacteria that cause decay are slow workers and ozone not only kills these bugs, but also primes the tooth surface so that remineralizing can begin. Human saliva is "supersaturated" with calcium and phosphates, which allow teeth to heal and cavities to close. But ozone poses a danger, as well, so this technology uses a method to ensure that the gas goes only into the hole, not the patient's mouth. A small rubber cap is fitted over the tooth and the hole is hit by a concentrated blast of ozone for up to 40 seconds. It is then suctioned out.
So far, the treatment has been used in more than 100 test facilities around the world. The success rate is around 99%, and there are no reports of treated teeth re-decaying. For patients, the treatment will mean that for most cavities there will be no need for drilling - eliminating the noise, smell and discomfort that it can cause. 100% of patients who have had the treatment say they would want it again if they needed another filling. It can be used as a preventative measure as well: children will never need fillings if they continue treatment. Healthy teeth would need to be treated every six months or so, perhaps as part of a routine checkup. |
|
Vitamins |
Vitamin B6 (Pyridoxine) |
| | | | |
KEY | | Proven definite or direct link |  | | Very strongly or absolutely counter-indicative | | | May do some good | | | Likely to help | | | Highly recommended |
GLOSSARY
Bacteria (Bacterial, Bacterium)
Microscopic germs. Some bacteria are "harmful" and can cause disease, while other "friendly" bacteria protect the body from harmful invading organisms.
Calcium
The body's most abundant mineral. Its primary function is to help build and maintain bones and teeth. The body also needs calcium to carry nerve signals, keep the heart functioning, contract muscles, clot blood and maintain healthy skin. Calcium helps control blood acid-alkaline balance, plays a role in cell division, muscle growth and iron utilization, activates certain enzymes, and helps transport nutrients through cell membranes. Calcium also forms a cellular cement called ground substance that helps hold cells and tissues together.
Carbohydrates (Carbohydrate)
The sugars and starches in food. Sugars are called simple carbohydrates and found in such foods as fruit and table sugar. Complex carbohydrates are composed of large numbers of sugar molecules joined together, and are found in grains, legumes, and vegetables like potatoes, squash, and corn.
Checkup (Check-up, Checkups, Check-ups)
A thorough physical examination that includes a variety of tests depending on the age, sex and health of the person.
Chemotherapy
A treatment of disease by any chemicals. Used most often to refer to the chemical treatments used to combat cancer cells. Chemotherapy is usually given in cycles: a treatment period followed by a recovery period, then another treatment period, and so on. Most anticancer drugs are given by injection into a blood vessel (IV); some are given by mouth. Chemotherapy is a systemic therapy, meaning that the drugs enter the bloodstream and travel throughout the body. Usually, a patient has chemotherapy as an outpatient (at the hospital, at the doctor's office, or at home). However, depending on which drugs are given and the patient's general health, a short hospital stay may be needed.
Lesion (Lesions)
Any damage to tissue structure or function; an abnormal change in body tissue caused by disease or injury. A scar is a lesion, as is cancer, a stomach ulcer or a pimple.
Magnesium
An essential mineral. The chief function of magnesium is to activate certain enzymes, especially those related to carbohydrate metabolism. Another role is to maintain the electrical potential across nerve and muscle membranes. It is essential for proper heartbeat and nerve transmission. Magnesium controls many cellular functions. It is involved in protein formation, DNA production and function and in the storage and release of energy in ATP. Magnesium is closely related to calcium and phosphorus in body function. The average adult body contains approximately one ounce of magnesium. It is the fifth mineral in abundance within the body--behind calcium, phosphorus, potassium and sodium. Although about 70 percent of the body's magnesium is contained in the teeth and bones, its most important functions are carried out by the remainder which is present in the cells of the soft tissues and in the fluid surrounding those cells.
Milligram (mg, Milligrams)
0.001 or a thousandth of a gram.
Radiation Therapy (Radiotherapy)
The use of high-energy rays to kill cancer cells. Depending on the stage of the disease, treatment with radiation may be given alone or with chemotherapy. Radiation therapy is local therapy; it affects cancer cells only in the treated area. External radiation does not cause the body to become radioactive. Most often, treatment is given on an outpatient basis in a hospital or clinic.
Saliva (Salivary)
The watery mixture of secretions from the salivary and oral mucous glands that lubricates chewed food and moistens the oral walls.
Syndrome
A medical condition characterized by a collection of related symptoms (what the patient feels) and signs (what a doctor can observe or measure).
Topical
Most commonly 'topical application': Administration to the skin.
Vitamin B6 (B6, B-6)
Influences many body functions including regulating blood glucose levels, manufacturing hemoglobin and aiding the utilization of protein, carbohydrates and fats. It also aids in the function of the nervous system.
Last updated: Jan 03, 2010
|
|
|
|
|
|
